Suflas Rebecca, Cox Rebecca, Viscardi Rose M, Leung Jocelyn C
Department of Pediatrics, Pediatrix Medical Group, Sinai Hospital of Baltimore, Baltimore, Maryland.
Department of Family Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
Am J Perinatol. 2025 Jul;42(10):1272-1280. doi: 10.1055/a-2483-5788. Epub 2024 Nov 25.
This study aimed to determine hearing screen outcomes and identify clinical and environmental risk factors for hearing screen failure in very preterm infants at a level IV single-family room (SFR) neonatal intensive care unit (NICU).We conducted a retrospective study of infants <33 weeks gestational age admitted to a level IV SFR NICU who survived to discharge and had automated auditory brainstem response results available. Demographics, antenatal and postnatal factors, and respiratory support modes and their duration were collected from the electronic medical record.Of 425 eligible infants with documented hearing screen results, 353 (83%) passed and 72 (17%) failed the hearing screen (unilateral, = 44 [61%]; bilateral, = 28 [39%]). Compared to infants who passed the hearing screen, infants with hearing screen failure were lower gestational age and birth weight, male sex, were screened at later postnatal and postmenstrual ages (PMAs), had lower 1- and 5-minute Apgar scores, longer duration of furosemide therapy, early hypotension, intraventricular hemorrhage (IVH) ≥Grade 3, and bronchopulmonary dysplasia (BPD) at 36 weeks PMA. Infants with hearing screen failure experienced longer exposures to invasive and noninvasive respiratory support. Heated, humidified, high flow nasal cannula >2 liters per minute exposure was significantly longer in infants with bilateral hearing screen failure (18.4 ± 18.4 d) compared to duration in infants who passed (7.4 ± 12.8 d) and those with unilateral failure (9 ± 13 d), (mean ± standard deviation [SD], < 0.001). In the final logistic model, IVH ≥Grade 3 (odds ratio [OR] = 3.22, 95% confidence interval [CI]: 1.15-8.98, = 0.026) and BPD (OR = 2.27, 95% CI: 1.25-4.11, = 0.007) were the factors with the greatest risk for hearing screen failure.We speculate that the association of BPD with hearing screen failure may be mediated, in part, by chronic noise exposure, including from respiratory support devices. Attention to hearing protection in at-risk infants during respiratory support may mitigate the risk of hearing loss. · NICU noise often exceeds recommended sound levels.. · Seventeen percent of infants with <33 weeks GA in SFR NICU failed hearing screenings.. · BPD and IVH are risk factors for hearing screen failure.. · Respiratory devices contribute to increased NICU noise.. · hearing protection should be considered during respiratory support..
本研究旨在确定四级单人病房（SFR）新生儿重症监护病房（NICU）中极早产儿听力筛查的结果，并识别听力筛查未通过的临床和环境风险因素。我们对孕周小于33周、入住四级SFR NICU且存活至出院并有自动听性脑干反应结果的婴儿进行了一项回顾性研究。从电子病历中收集人口统计学、产前和产后因素、呼吸支持模式及其持续时间。在425例有记录的听力筛查结果的合格婴儿中，353例（83%）通过了听力筛查，72例（17%）未通过（单侧，n = 44 [61%]；双侧，n = 28 [39%]）。与听力筛查通过的婴儿相比，听力筛查未通过的婴儿孕周和出生体重更低、为男性、在出生后和孕龄（PMA）更大时进行筛查、1分钟和5分钟阿氏评分更低、速尿治疗持续时间更长、早期低血压、脑室内出血（IVH）≥3级以及在PMA 36周时患有支气管肺发育不良（BPD）。听力筛查未通过的婴儿接受有创和无创呼吸支持的时间更长。与通过听力筛查的婴儿（7.4±12.8天）和单侧未通过的婴儿（9±13天）相比，双侧听力筛查未通过的婴儿接受每分钟>2升的加热、湿化、高流量鼻导管吸氧的时间显著更长（18.4±18.4天），（平均值±标准差[SD]，P<0.001）。在最终的逻辑模型中，IVH≥3级（比值比[OR]=3.22，95%置信区间[CI]：1.15 - 8.98，P = 0.026）和BPD（OR = 2.27，95% CI：1.25 - 4.11，P = 0.007）是听力筛查未通过风险最大的因素。我们推测BPD与听力筛查未通过之间的关联可能部分由慢性噪声暴露介导，包括来自呼吸支持设备的噪声。在呼吸支持期间关注高危婴儿的听力保护可能会降低听力损失的风险。· NICU噪声经常超过推荐声级。· SFR NICU中孕周<33周的婴儿中有17%听力筛查未通过。· BPD和IVH是听力筛查未通过的风险因素。· 呼吸设备导致NICU噪声增加。· 在呼吸支持期间应考虑听力保护。
